Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Cerebral Syphilitic Gumma Mimicking a Brain Tumor in the Relapse of Secondary Syphilis in a Human Immunodeficiency Virus-Negative Patient

  • Yoon, Young Kyung (Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine) ;
  • Kim, Min Ja (Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine) ;
  • Chae, Yang Seok (Division of Infectious Diseases, Department of Pathology, Korea University College of Medicine) ;
  • Kang, Shin-Hyuk (Division of Infectious Diseases, Department of Neurosurgery, Korea University College of Medicine)
  • Received : 2012.09.20
  • Accepted : 2013.02.25
  • Published : 2013.03.28
Download PDF
⟨ Previous Next ⟩

Abstract

Diagnosis of cerebral syphilitic gumma is frequently determined at the time of surgery, because imaging and laboratory findings demonstrate the elusive results. A 59-year-old woman presenting dysarthria showed a mass on her brain computed tomography. She was first suspected of brain tumor, but histological results from surgical resection revealed cerebral gumma due to neurosyphilis. After operation, she presented fever and rash with an infiltration on a chest X-ray. Histological assessment of skin was consistent with syphilis. Fluorescent treponemal antibody absorbed test IgG in cerebrospinal fluid was positive. She was successfully treated with ceftriaxone for 14 days.

Keywords

References

  1. Ances BM, Danish SF, Kolson DL, Judy KD, Liebeskind DS : Cerebral gumma mimicking glioblastoma multiforme. Neurocrit Care 2 : 300-302, 2005 https://doi.org/10.1385/NCC:2:3:300
  2. Berger JR, Waskin H, Pall L, Hensley G, Ihmedian I, Post MJ : Syphilitic cerebral gumma with HIV infection. Neurology 42 : 1282-1287, 1992 https://doi.org/10.1212/WNL.42.7.1282
  3. Brightbill TC, Ihmeidan IH, Post MJ, Berger JR, Katz DA : Neurosyphilis in HIV-positive and HIV-negative patients : neuroimaging findings. AJNR Am J Neuroradiol 16 : 703-711, 1995
  4. Clark EG, Danbolt N : The Oslo study of the natural history of untreated syphilis; an epidemiologic investigation based on a restudy of the Boeck-Bruusgaard material; a review and appraisal. J Chronic Dis 2 : 311-344, 1955 https://doi.org/10.1016/0021-9681(55)90139-9
  5. Cnossen WM, Niekus H, Nielsen O, Vegt M, Blansjaar BA : Ceftriaxone treatment of penicillin resistant neurosyphilis in alcoholic patients. J Neurol Neurosurg Psychiatry 59 : 194-195, 1995 https://doi.org/10.1136/jnnp.59.2.194
  6. Coleman DL, McPhee SJ, Ross TF, Naughton JL : Secondary syphilis with pulmonary involvement. West J Med 138 : 875-878, 1983
  7. Darwish BS, Fowler A, Ong M, Swaminothan A, Abraszko R : Intracranial syphilitic gumma resembling malignant brain tumour. J Clin Neurosci 15 : 308-310, 2008 https://doi.org/10.1016/j.jocn.2006.07.023
  8. Fargen KM, Alvernia JE, Lin CS, Melgar M : Cerebral syphilitic gummata : a case presentation and analysis of 156 reported cases. Neurosurgery 64 : 568-575; discussioin 575-576, 2009 https://doi.org/10.1227/01.NEU.0000337079.12137.89
  9. Gentile JH, Viviani C, Sparo MD, Arduino RC : Syphilitic meningomyelitis treated with ceftriaxone : case report. Clin Infect Dis 26 : 528, 1998 https://doi.org/10.1086/517112
  10. Holland BA, Perrett LV, Mills CM : Meningovascular syphilis : CT and MR findings. Radiology 158 : 439-442, 1986 https://doi.org/10.1148/radiology.158.2.3941870
  11. Horowitz HW, Valsamis MP, Wicher V, Abbruscato F, Larsen SA, Wormser GP, et al. : Brief report : cerebral syphilitic gumma confirmed by the polymerase chain reaction in a man with human immunodeficiency virus infection. N Engl J Med 331 : 1488-1491, 1994 https://doi.org/10.1056/NEJM199412013312204
  12. Lee CW, Lim MJ, Son D, Lee JS, Cheong MH, Park IS, et al. : A case of cerebral gumma presenting as brain tumor in a human immunodeficiency virus (HIV)-negative patient. Yonsei Med J 50 : 284-288, 2009 https://doi.org/10.3349/ymj.2009.50.2.284
  13. Lee JP, Koo SH, Jin SY, Kim TH : Experience of meningovascular syphilis in human immunodeficiency virus infected patient. J Korean Neurosurg Soc 46 : 413-416, 2009 https://doi.org/10.3340/jkns.2009.46.4.413
  14. Lukehart SA, Hook EW 3rd, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH : Invasion of the central nervous system by Treponema pallidum : implications for diagnosis and treatment. Ann Intern Med 109 : 855-862, 1988 https://doi.org/10.7326/0003-4819-109-11-855
  15. Marra CM, Boutin P, McArthur JC, Hurwitz S, Simpson PA, Haslett JA, et al. : A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Clin Infect Dis 30 : 540-544, 2000 https://doi.org/10.1086/313725
  16. Marra CM, Maxwell CL, Smith SL, Lukehart SA, Rompalo AM, Eaton M, et al. : Cerebrospinal fluid abnormalities in patients with syphilis : association with clinical and laboratory features. J Infect Dis 189 : 369-376, 2004 https://doi.org/10.1086/381227
  17. Oblu N : Handbook of Clinical Neurology. New York : Elsevir, 1975
  18. Pall HS, Williams AC, Stockley RA : Intracranial gumma presenting as a cerebral tumour. J R Soc Med 81 : 603-604, 1988
  19. Rolfs RT, Joesoef MR, Hendershot EF, Rompalo AM, Augenbraun MH, Chiu M, et al. : A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group. N Engl J Med 337 : 307-314, 1997 https://doi.org/10.1056/NEJM199707313370504
  20. Shann S, Wilson J : Treatment of neurosyphilis with ceftriaxone. Sex Transm Infect 79 : 415-416, 2003 https://doi.org/10.1136/sti.79.5.415
  21. Simon RP : Neurosyphilis. Arch Neurol 42 : 606-613, 1985 https://doi.org/10.1001/archneur.1985.04060060112021
  22. Uemura K, Yamada T, Tsukada A, Enomoto T, Yoshii Y, Nose T : Cerebral gumma mimicking glioblastoma on magnetic resonance images--case report. Neurol Med Chir (Tokyo) 35 : 462-466, 1995 https://doi.org/10.2176/nmc.35.462

Cited by

  1. Cerebral Gumma Mimicking a Brain Tumor in a Human Immunodeficiency Virus-Negative Patient: A Case Report vol.69, pp.3, 2013, https://doi.org/10.3348/jksr.2013.69.3.181
  2. Meningovascular and Spinal form of Neurosyphilis Presenting as Multiple Cranial Nerve Palsy, Cerebral Infarction and Meningomyelitis in a Human Immunodeficiency Virus Negative-Patient: MR Imaging Feat vol.18, pp.3, 2013, https://doi.org/10.13104/jksmrm.2014.18.3.263
  3. Unusual Presentation of Secondary Syphilis in Korea: 2010-2014 Review vol.10, pp.1, 2015, https://doi.org/10.14777/kjutii.2015.10.1.19
  4. Changes in neurosyphilis presentation: a survey on 286 patients vol.30, pp.11, 2013, https://doi.org/10.1111/jdv.13753
  5. Diagnosis and Treatment of Cerebral Syphilitic Gumma: A Report of Three Cases vol.12, pp.None, 2013, https://doi.org/10.3389/fnins.2018.00100
  6. A case of secondary syphilis with pulmonary involvement and review of the literature vol.29, pp.10, 2013, https://doi.org/10.1177/0956462418765834
  7. Multiple intracranial and spinal cord syphilitic gummas in a human immunodeficiency virus-negative man with untreated syphilis : A case report vol.98, pp.36, 2019, https://doi.org/10.1097/md.0000000000016887
  8. Diagnosis and Treatment of Spinal Syphilitic Gumma: A Case Report vol.10, pp.None, 2019, https://doi.org/10.3389/fneur.2019.01352
  9. Re-emerging Neurosyphilis in Korea as a Possible Etiology of Psychotic Disorders with Pleomorphic Symptoms and Cognitive Dysfunction: a Case Report and Literature Review vol.35, pp.33, 2013, https://doi.org/10.3346/jkms.2020.35.e271
  10. Case Report: Microglia Composition and Immune Response in an Immunocompetent Patient With an Intracranial Syphilitic Gumma vol.11, pp.None, 2013, https://doi.org/10.3389/fneur.2020.615434
  11. Syphilitic Gummata in the Central Nervous System: A Narrative Review and Case Report about a Noteworthy Clinical Manifestation vol.9, pp.5, 2013, https://doi.org/10.3390/microorganisms9050906
  12. Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male vol.8, pp.9, 2013, https://doi.org/10.1093/ofid/ofab455